Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) Robotic Radical Prostatectomy: Lessons from 500 cases

Jonathan Noel, Siya Lodhia, Seiver Karim, Surina Taneja, Darius Moghanchizadeh, Ashwin Sunil Tamhankar, Rajiv Swamy, Samita Agarwal, Tim M. Lane, James Adshead, Nikhil Vasdev

Research output: Contribution to journalArticlepeer-review


To report the United Kingdom’s largest single centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using NeuroSAFE. To examine its’ efficacy on histopathological, functional and oncological outcomes, in order to educate other Units in their early stage of adoption of this technique.
Over a 7 year period from November 2012 – December 2019, 520 patients underwent RALP with NeuroSAFE at Lister Hospital, East & North Hertfordshire NHS Trust. To measure its impact, prospective data collection on patient parameters, frozen section (FS) margin/s and confirmatory paraffin analysis was performed. Variables assessed during RALP included overall operative and frozen section report duration; post surgical outcomes in continence, potency and prostate specific antigen (PSA) trend and biochemical recurrence (BCR) are reported.
The mean (range) operative console time of our NeuroSAFE RALPs was 150 (90–300) minutes. The average time of FS processing to report was 35 minutes. The positive margin rate on FS was 30.7% (160/520), with a confirmation on paraffin analysis in 91.8% of cases (147/160). The neurovascular bundles (NVBs) that underwent secondary resection, contained cancer in 26.8% (43/160) of cases. 77.5% T2, 22.3% T3 cancer were found on final prostate specimen analysis. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. Of 316 cases who had bilateral nerve spare (NS) 21.5% (62/288) are spontaneously potent and 29.5% (85/288) are capable of intercourse with oral PDE5 inhibitors.
Our experience with this technique of RALP shows promising long-term outcomes. NeuroSAFE enables intra operative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE could be converted to a negative surgical margin (NSM) by secondary wide resection. No other technique at present, can offer feedback on NS by a Pathologist in real time.

Original languageEnglish
JournalJournal of robotic surgery
Publication statusAccepted/In press - 13 Oct 2021


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